Health and Economy in COVID-19 Era: A Plan for Reconstituting Long-Term Economic Security.

COVID-19 is a rapidly evolving pandemic, which represents a multifaceted global threat. Given the economic consequences, most researchers agree that social distancing measures are an effective strategy relative to the cost. Previous studies indicate that community size as well as viral population risk groups should be considered in forming an effective targeted social distancing strategy. The resultant delay in the occurrence of infections in order to support vaccine development has been shown to be an effective policy. However, a return to normalcy from the current situation would require policy intervention that transforms the American economy along with continued targeted social distancing and the use of medical science as a tool to facilitate gradual personal interactions of low-risk individuals. We believe that the adoption of rapid IgG testing would be best suitable for widespread population-level screening as part of a comprehensive plan for incrementally rebuilding the in-person workforce. As such, this crisis represents an opportunity for the United States to increase automation of the manufacturing sector, shrink supply chains, and create higher-level jobs in order to reduce the dependency on other countries for critical supplies. This economic transition to better utilize technology along with reconstruction of the workforce could improve the standard of living for many Americans as well as better prepare the US for future pandemics.

Hospital costs in the US for pulmonary mycobacterial diseases.

BACKGROUND: Pulmonary mycobacterial diseases describe both tuberculosis (TB) and nontuberculous mycobacteria (NTM). Few data are available measuring the cost burden of mycobacterial diseases at the national level. The purpose of this study is to evaluate the cost burden and measure emerging trends in hospitalization of pulmonary TB and NTM cases in the United States from 2001 through 2012. METHODS: This study is a retrospective, community-based cost analysis of hospitalized patients with a principal diagnosis of pulmonary mycobacterial diseases from 2001 through 2012. Data for pulmonary TB and NTM were retrieved from the Healthcare Cost and Utilization Project (HCUP), US Department of Health and Human Services. The statistical significance of observed trends of NTM and TB national hospital costs was calculated using Poisson log-linear regression. RESULTS: 20,049 hospital discharges were reported for pulmonary NTM and 69,257 for pulmonary TB in the US from 2001 through 2012. The total associated cost of these discharges was $903,767,292 for pulmonary NTM and $2,078,113,317 for pulmonary TB. During the study period, the national hospital costs of pulmonary NTM increased at a statistically significant rate in the US over each year (P = 0.001). However, no such increase was found for national hospital costs of pulmonary TB. CONCLUSIONS: The national hospital cost of NTM management is increasing. These results emphasize the importance of continued research in pulmonary NTM in order to improve current guidelines in prevention and treatment strategies.

Pneumococcal vaccine and patients with pulmonary diseases.

Chronic pulmonary diseases are chronic diseases that affect the airways and lung parenchyma. Examples of common chronic pulmonary diseases include asthma, bronchiectasis, chronic obstructive lung disease, lung fibrosis, sarcoidosis, pulmonary hypertension, and cor pulmonale. Pulmonary infection is considered a significant cause of mortality in patients with chronic pulmonary diseases. Streptococcus pneumoniae is the leading isolated bacteria from adult patients with community-acquired pneumonia, the most common pulmonary infection. Vaccination against S. pneumoniae can reduce the risk of mortality, especially from more serious infections in both immunocompetent and immunocompromised patients. Patients with chronic pulmonary diseases who take steroids or immunomodulating therapy (eg, methotrexate, anti-tumor necrosis factor inhibitors), or who have concurrent sickle cell disease or other hemoglobinopathies, primary immunodeficiency disorders, human immunodeficiency virus infection/acquired immunodeficiency syndrome, nephrotic syndrome, and hematologic or solid malignancies should be vaccinated with both 13-valent pneumococcal conjugate vaccine and the pneumococcal polysaccharide vaccine 23-valent.

Highlight on advances in nontuberculous mycobacterial disease in North America.

Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and exist as an important cause of pulmonary infections in humans. Pulmonary involvement is the most common disease manifestation of NTM and the incidence of NTM is growing in North America. Susceptibility to NTM infection is incompletely understood; therefore preventative tools are not well defined. Treatment of pulmonary nontuberculous mycobacterial (NTM) infection is difficult and entails multiple antibiotics and an extended treatment course. Also, there is a considerable variation in treatment management that should be considered before initiating treatment. We highlight the new findings in the epidemiology diagnosis and treatment of mycobacterial infections. We debate new advances regarding NTM infection in cystic fibrosis patients and solid organ transplant recipients. Finally, we introduce a new epidemiologic model for NTM disease based on virulence-exposure-host factors.